ADVANCED GASTRIC CANCER
TREATMENT IN CHINA
A comprehensive guide to advanced gastric cancer treatment options available at specialist Chinese oncology centres โ from first-line systemic therapy and targeted agents to immunotherapy, novel biomarker-driven agents, and clinical trials.
analyticsAt a Glance
- check_circleChina has developed and approved several gastric cancer treatments ahead of Western markets โ including nivolumab, sintilimab, and zolbetuximab
- check_circleClaudin 18.2 (CLDN18.2) targeted therapy โ available in China before most other markets
- check_circleActive CAR-T cell therapy trials for CLDN18.2+ and HER2+ gastric cancer at major Chinese centres
- check_circleCancerFax coordinates full access to Chinese gastric cancer specialists โ from records review to treatment logistics
Why China for Advanced Gastric Cancer?
Gastric cancer is China's second most common cancer by incidence โ a disease burden that has driven extraordinary investment in clinical research, drug development, and treatment infrastructure. Chinese academic centres have led global gastric cancer trials, gained early regulatory approval for novel agents, and developed treatment approaches that are only now reaching Western practice guidelines.
โFor gastric cancer, China is not a second option โ it is where much of the world's most advanced clinical work on this disease is actually happening.โ
Early Access to Novel Agents
China's NMPA (National Medical Products Administration) has approved several gastric cancer agents โ including nivolumab, sintilimab, camrelizumab, and zolbetuximab โ often ahead of or concurrent with Western regulators, giving Chinese patients and international patients seeking care in China early access to cutting-edge therapies.
Claudin 18.2 โ A Chinese Clinical Speciality
CLDN18.2 is the most important novel gastric cancer biomarker of this decade, and Chinese centres โ which conducted many of the pivotal trials โ have the deepest experience in CLDN18.2 testing, patient selection, and treatment with zolbetuximab and emerging CAR-T approaches.
Active Trial Infrastructure
China is second only to the United States in the number of active oncology clinical trials. For gastric cancer specifically, China hosts more active Phase II/III trials than any other country โ including trials of novel PD-1 combinations, bispecific antibodies, ADCs, and cellular therapies.
Cost Advantage Without Quality Compromise
Major Chinese academic cancer centres (PUMCH, Sun Yat-sen University Cancer Center, Fudan University Shanghai Cancer Center, and others) operate at international quality standards โ JCI or HIMSS accreditation โ at 30โ60% of equivalent Western treatment costs.
Treatment Decision Pathway by Biomarker Profile
Gastric cancer treatment in 2024โ2025 is increasingly biomarker-driven. These are the key molecular tests and the treatment decisions they inform.
- 1
HER2 Testing (IHC + ISH)
HER2 positivity (IHC 3+ or IHC 2+/ISH amplified) defines the subset (~15โ20% of gastric cancers) for whom trastuzumab, trastuzumab deruxtecan (T-DXd), or HER2-directed CAR-T therapy is the priority consideration. HER2 testing should be performed on all newly diagnosed advanced gastric cancers.
- 2
CLDN18.2 Testing (IHC)
Claudin 18.2 expression โ defined as โฅ75% of tumour cells with moderate-to-strong (2+/3+) membranous staining โ identifies patients eligible for zolbetuximab. CLDN18.2 positivity is present in approximately 38โ40% of gastric cancers and is particularly important in CLDN18.2+/HER2โ patients.
- 3
MSI/MMR Testing
MSI-H/dMMR gastric cancer (~5โ10%) benefits from pembrolizumab or nivolumab as first-line therapy or maintenance. MSI status informs both immunotherapy selection and prognosis.
- 4
PD-L1 Expression (CPS Scoring)
Combined Positive Score (CPS) โฅ5 identifies the majority of gastric cancer patients who benefit from adding nivolumab to chemotherapy (CheckMate-649). PD-L1 CPS should be assessed alongside HER2 and MSI as part of routine biomarker profiling.
- 5
FGFR2b Expression
Emerging biomarker for bemarituzumab eligibility. FGFR2b overexpression identifies a subgroup with survival benefit from bemarituzumab + mFOLFOX6 โ available through clinical trials in China.
Advanced Gastric Cancer Treatment Options Available in China
A comprehensive overview of the systemic treatment options for advanced gastric cancer accessible at Chinese specialist centres โ including approved agents and trial-available therapies.
| Treatment | Biomarker / Patient Group | Line of Therapy | Availability in China |
|---|---|---|---|
| FLOT / FOLFOX / XELOX / SOX | All advanced gastric cancer | 1st line | Standard โ all major centres |
| Nivolumab + chemotherapy (CheckMate-649) | PD-L1 CPS โฅ5 | 1st line | NMPA approved โ widely available |
| Sintilimab / camrelizumab + chemo | PD-L1 positive | 1st line | NMPA approved Chinese PD-1 โ widely available |
| Trastuzumab + chemotherapy (ToGA) | HER2+ (IHC3+ or 2+/ISH+) | 1st line | Standard โ all major centres |
| Trastuzumab deruxtecan (T-DXd) | HER2+ (IHC3+ or 2+) | 2nd line+ | NMPA approved / available at major centres |
| Zolbetuximab + chemotherapy | CLDN18.2 high / HER2โ | 1st line | NMPA approved 2024 โ specialist centres |
| Ramucirumab ยฑ paclitaxel | All advanced gastric cancer | 2nd line | Available at major centres |
| Pembrolizumab | MSI-H or PD-L1 CPS โฅ10 | 1st / 2nd line | Available at major centres |
| Bemarituzumab + mFOLFOX6 | FGFR2b overexpressing | 1st line (trial) | Active trials at Chinese centres |
| CLDN18.2-directed CAR-T therapy | CLDN18.2+ (high expression) | 2nd/3rd line (trial) | Phase I/II trials โ major Chinese centres |
| HER2-directed CAR-T therapy | HER2+ gastric cancer | 2nd/3rd line (trial) | Phase I/II trials โ major Chinese centres |
China vs Western Centres โ What's Different for Gastric Cancer?
Patients considering treatment in China versus seeking treatment in Europe or North America should understand the key clinical and practical differences.
Treatment in China
- Earlier access to CLDN18.2 therapyZolbetuximab was approved by NMPA in China in 2024 โ it remains pending or recently approved in the US/EU, with less widespread institutional access.
- Broader clinical trial accessChina hosts more active gastric cancer trials per patient population than most Western markets โ including first-in-class agents not yet in Western trials.
- Lower treatment costChinese domestic PD-1 inhibitors (sintilimab, camrelizumab) and trastuzumab biosimilars are available at 20โ40% of Western originator drug costs.
- High-volume gastric cancer expertiseChinese surgical oncologists and medical oncologists treat volumes of gastric cancer patients that most Western institutions never reach โ producing genuinely superior case experience.
Treatment in Western Centres
- Nivolumab / pembrolizumab originator preferredWestern oncologists and guidelines recommend the originator PD-1 inhibitors; Chinese biosimilar equivalents may not be accepted by Western insurers for continuation at home.
- Multidisciplinary tumour board cultureMajor Western cancer centres have established MDT cultures โ though Chinese academic centres increasingly operate equivalent tumour board structures.
- Language and healthcare navigationNon-Mandarin speaking patients require coordinated language support โ a practical barrier that CancerFax manages but that increases the logistical complexity of treatment in China.
- Post-treatment continuity at homePatients treated in China may face challenges obtaining continued prescriptions for Chinese-approved agents through their home healthcare system โ advance planning is essential.
Gastric Cancer in China โ Key Numbers
Contextual figures that explain why China has developed such deep expertise in gastric cancer treatment.
- #2Gastric cancer's incidence rank among all cancers in ChinaChina accounts for approximately 43% of all global gastric cancer cases โ making it the world's largest gastric cancer treatment infrastructure.
- ~38โ40%Proportion of gastric cancers with high CLDN18.2 expressionA substantial biomarker-defined population eligible for zolbetuximab โ and for whom Chinese centre experience is unmatched globally.
- 30โ60%Approximate cost saving vs equivalent treatment in the USA/UKParticularly significant for trastuzumab, PD-1 inhibitors, and novel targeted agents where Chinese domestic or biosimilar versions are substantially cheaper.
More from the Gastric Cancer Resource Library
Explore our complete gastric and oesophageal cancer series โ from specific biomarker guides to immunotherapy and novel agents.
Frequently Asked Questions: Advanced Gastric Cancer Treatment in China
Which Chinese hospitals specialise in advanced gastric cancer?
The leading Chinese centres for advanced gastric cancer include Sun Yat-sen University Cancer Center (Guangzhou), Fudan University Shanghai Cancer Center, Peking University Cancer Hospital, Union Hospital of Tongji Medical College (Wuhan), and Zhongshan Hospital (Shanghai). These institutions have the highest gastric cancer patient volumes in China and the deepest experience with novel biomarker-driven therapies including CLDN18.2-targeted treatment and PD-1 immunotherapy. CancerFax matches patients to the most appropriate centre based on their specific biomarker profile and treatment needs.
Can I access zolbetuximab (CLDN18.2-targeted therapy) in China if it is not yet approved where I live?
Yes. Zolbetuximab received NMPA approval in China in 2024 for CLDN18.2-high, HER2-negative advanced gastric cancer in the first-line setting. Patients from countries where zolbetuximab is not yet approved or accessible can receive it at qualifying Chinese cancer centres. CancerFax verifies CLDN18.2 testing adequacy from your pathology report and identifies centres with confirmed zolbetuximab availability before coordinating your visit.
Do I need all biomarker tests done before contacting CancerFax?
Ideally, yes โ HER2, CLDN18.2, MSI/MMR, and PD-L1 testing should be performed before or soon after diagnosis to guide treatment selection. However, if your existing pathology does not include all of these, CancerFax can arrange additional IHC testing on archival tumour tissue either in your home country or on arrival at the Chinese centre. We specify exactly which tests are needed as part of the pre-treatment case review.
How CancerFax Helps
CancerFax is a specialist cancer access and patient-navigation platform. We help patients and families understand their options, organise medical records, coordinate hospital communication, and support cross-border treatment planning where appropriate.
We help collect and organise reports, scans, pathology, biomarker results, and treatment history for structured case review.
We communicate with hospitals or trial teams to assess whether a case may be suitable for further screening.
We support appointment coordination, document submission, translation, and direct communication with international departments.
For international patients, we help with practical coordination โ travel planning, hospital admission guidance, and local support.
If this option is not suitable, we help explore other relevant treatments, clinical trials, or advanced care pathways.
From inquiry through to follow-up, our coordinators provide a single point of contact for the family.
CancerFax does not guarantee treatment access, eligibility, or clinical outcome. Our role is to help patients access accurate information, structured review, and appropriate specialist pathways.
Looking for Advanced Gastric Cancer Treatment Options in China?
CancerFax reviews your gastric cancer records โ staging, HER2 status, CLDN18.2 expression, MSI status, and prior treatment history โ and identifies the most appropriate treatment options at specialist Chinese oncology centres.
This content is for informational purposes only and does not constitute medical advice. Always consult a qualified oncologist before making treatment decisions.